Why Cardiac Assessment Matters
Cardiac assessments are one of those skills you’ll use everywhere — on the ward, in clinicals, during handover, and definitely in exams. As nurses, we’re often the first to notice subtle changes, so knowing what’s normal (and what isn’t) is key.
A good cardiac assessment isn’t about memorising everything — it’s about following a structured approach and knowing what to look for.
Step 1: Patient History
Before touching the patient, start with the basics.
Ask about:
- Chest pain, pressure, or tightness
- Shortness of breath (at rest or exertion)
- Dizziness, fatigue, or palpitations
- Past cardiac history (e.g. hypertension, AF, heart failure)
- Cardiac medications
- Peripheral swelling
These answers help guide what you’ll focus on during your assessment.
Step 2: Vital Signs
Vital signs tell you how well the heart is coping right now.
Pay close attention to:
- Blood pressure (high, low, or trending changes)
- Heart rate (normal adult range: 60–100 bpm)
- Respiratory rate (often increases before deterioration)
- Oxygen saturation
- Temperature
Changes in vital signs are often the earliest sign of cardiac compromise — which is why having a quick vital signs reference on hand is so helpful during placements.
Step 3: Inspection
Look before you listen.
Check for:
- Pallor, cyanosis, or flushed skin
- Shortness of breath or increased work of breathing
- Peripheral oedema (ankles, feet, sacral area)
- Jugular venous distension (30–45°)
- Pacemakers, scars, or implanted devices
Inspection gives you clues before you even touch the stethoscope.
Step 4: Palpation
Now assess circulation and perfusion.
- Palpate peripheral pulses (radial, dorsalis pedis)
- Assess rate, rhythm, strength, and equality
- Check capillary refill (< 2 seconds)
- Assess skin temperature
- Check for and grade oedema
Unequal or weak pulses should always be escalated.
Step 5: Auscultation
Auscultate systematically using your stethoscope.
Listen at the four valve areas:
- Aortic
- Pulmonic
- Tricuspid
- Mitral (apex)
Listen for:
- Heart rate and rhythm
- Normal heart sounds (S1 & S2)
- Extra sounds or murmurs
If the rhythm is irregular, count the apical pulse for a full minute.
Red Flags to Escalate 🚨
Always act on:
- Chest pain
- New or worsening shortness of breath
- Irregular or extreme heart rates
- Sudden blood pressure changes
- Cool, clammy skin or poor perfusion
- Syncope or acute confusion
If something feels off — trust your assessment.
Final Tip
Cardiac assessments get easier with repetition. Using cardiology and vital signs reference cards can help you quickly check normal ranges, assessment steps, and red flags — especially during busy shifts or clinical placements.